A nurse is caring for a 7-year-old child who has a urinary tract infection (UTI) in the pediatric unit.

Exhibits

For each of the following interventions, click to specify if the potential intervention is anticipated or contraindicated for the client.

Choice A rationale: A hemoglobin of 6.8 g/dL is significantly below the normal range for a 4-year-old. This finding indicates ongoing anemia, which is a common complication of leukemia rather than a therapeutic response.

Choice B rationale: An RBC count of 5/mm³ falls within the normal pediatric range. In leukemia, the bone marrow is crowded with blast cells; a normal RBC count suggests the marrow is recovering and producing healthy cells.

Choice C rationale: A WBC count of 15,000/mm³ is elevated. In acute lymphoblastic leukemia, high WBC counts often represent an overabundance of immature, non-functional leukemic blast cells, suggesting the disease is still active.

Choice D rationale: A platelet count of 98,000/mm³ indicates thrombocytopenia. While common during chemotherapy, a therapeutic effect would be demonstrated by a return toward the normal range of 150,000 to 400,000/mm³.

The correct answer is D. “Use a soft-bristled toothbrush when platelet levels are low.”.

Choice A rationale

Rinsing the child’s mouth with chlorhexidine mouthwash if they develop stomatitis is not recommended. Chlorhexidine can be harsh and may cause further irritation in a child with stomatitis.

Choice B rationale

Ensuring the administration of an antiemetic for 12 hours after chemotherapy is not sufficient. Antiemetics should be given before, during, and after chemotherapy to effectively manage nausea and vomiting.

Choice C rationale

Encouraging eating by providing the child with their favorite foods is not always appropriate. Some foods may exacerbate nausea or be contraindicated during chemotherapy.

Choice D rationale

Using a soft-bristled toothbrush when platelet levels are low is correct. This helps prevent gum bleeding and injury, which is important for children with low platelet counts due to chemotherapy.